Permit CITY OF TIGARb ELECTRICAL PERMIT
PERMIT #: ELC2005 -00464
ti All,016, ' DEVELOPMENT SERVICES DATE ISSUED: 6/30/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111AD -04700
SITE ADDRESS: 08990 SW PINEBROOK ST ZONING: R-4.5
SUBDIVISION: PINEBROOK TERRACE LOT : 070 JURISDICTION: TIG
Project Description: 4 branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
SHANE & KAR PILO WEBER ELECTRIC INC
8990 PINEBROOK ST. PO BOX 231154
TIGARD, OR 97224 TIGARD, OR 97281
Phone: 503- 267 -6321 Phone: 503 - 620 -1906
FEES Reg #: LIC 44087
SUP 4028S
Description Date Amount ELE 34 -442c
[ELPRMT] ELC Permit 6/30/2005 $66.80
[TAX] 8% State Surcharge 6/30/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or : - . -
Issued By: ` m _ , . _ mo A • Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
E;'
Electrical Permit A i� t1 6 N • FOR OFFICE USE ONLY
Received / /���
City: of Tigard 2005 Date/By: 30/67 /3I) Permit No. i� O�vf- Oti /
13125 SW Hall Blvd., Tigard, OR 97223 IIJ Plan Revievi
Phone: 503.639.4171 Fax: 503.598.1960 'L- •' ti \ Date Other Per
.
Inspection Line: 503.639.4175 CITY OF TIGAR' J J 6 .11. Date ReadyBy: ®See Page 2 for
Internet: www.ci.tigard.or.us RI➢ OQ p t p� DI VISI ON Notified/Method: /q Supplemental Information
`
❑ New construction ddition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' CATEGORY OF CONSTRUCTION ., , - of I- and 2- family dwellings 4 or more new residential
A l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ['Building over three stories ❑Feeders, 400 amps or more
❑ Other:
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION - ❑E plan RV park
Job no.: Job site address: _ ❑Health - care facility ❑Other:
S 9 91 s(„) P r e k rJ / Submit 2 sets of plans with any of the above.
City/State /ZIP: l; 5 �. 9( 9 7 � �4 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
YV7IsC_ (J€Li Q I )Cl /'e_ Services or feeders installation, alteration, and/or relocation
rep Ovit 200 amps or less 80.30 2
' IKPROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: il Zt nP 3 6 ?e of on / 14, 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: !! Temporary services or feeders installation, alteration, and/or
Phone: (503) 2 �0 7- (9 3-2..i Fax: ( ) 2 00 a
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT . , ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit l 46.85 .i4 , 85 2
Address: Each add'I branch circuit 3 6.65 /9, 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
/ extension" Describe: Page 2 2
Business name: �e6r 6Lac (r4. .J — Y►C_
Address: p — � 2 -31 / S4 Each additional inspection over allowable in any of the above
! Per inspection 62.50
City/State /ZIP: I G &r & e D 2 9 72. —i 15 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( 5 Lc I ( q B a Fax: (56j 62 — cat?
- ELECTRICAL PERMIT FEES*. ,
CCB Lic.: ti 9 v 8 7 Electrical Lic.31,_ 192d Suprv. Lic.:y) Zg S Subtotal 66, 8 0
Suprv. Electrician signature, required: �‘ er z_ .. j , Z r „ \„. Plan review (25% of permit fee)
Print name: �/j/) L� Date: State surcharge (8% of permit fee) 3 (J
' C `�� -� TOTAL PERMIT FEE ,9„ ,
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
"RESIDENTIAL WORK ONLY: _T •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: ` --
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Prnnits\ELC•PemtitApp.doc 04/03
- CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELC2005 -00464
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/30/20055
Phone: (503) 639 -4171 ,v e' gp,gIr
Inspection Requests (24 Hrs.): (503) 639 -4175 - :_.. .
INSPECTION WORKSHEET FOR DATE: 7/1/2005 TIME: 7:14AM PAGE: 12
. ek(:)(1 A NI-1..... 14 '''' G 411.1-1
SITE ADDRESS: - 08990 SW PINEBROOK ST CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: 070 TYPE OF USE:
PROJECT NAME: PILO
DESCRIPTION: 4 branch circuits.
OWNER: PILO, SHANE & KAREN PHONE #: 503 -267 -6321
CONTRACTOR: WEBER ELECTRIC INC PHONE #: 503 - 620 -1906
Inspection Request Scheduled For: Dater 7/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 010644 -01 503.819 -7380 N
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/
Inspector: " / � - Date: / N ■ I 6l( Phone #: (503) 718-